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.. _ ; ,._ �„� <br /> �; � _ <br /> .. . � <br /> . _ . t; <br /> � " ��-� , ;. �� <br /> [ - � <br /> WOOD BURNING EQUIPMENT -...;: , ,�-. . . � �� <br /> Wood stove with flue ,� �J � ��` <br /> Wood combination or add-on � '' <br /> Factory fireplace with flue <br /> • Factory Fireplace (s) Freestanding Masonry � <br /> Wood Stove (s} Franklin, other � <br /> Brand Name Model No. ; <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION � <br /> No. Kitchen Exhaust ducted recirculating cfm � <br /> No. Bath Exhaust (must be ducted outside) cfm � <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation � Removal <br /> � Fuel oiL �pzSo gallons � underground inside X outside <br /> LP Gas: � gallons � <br /> Other Gas opening � <br /> PERMIT FEE CALCULATION h <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) i� <br /> x .0125 $ � <br /> (contract price) � <br /> � 2. State SurcharL�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ � <br /> or $.50, whichever is greater (contract price) �! <br /> �: II <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 II <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted <br /> 4� <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the i <br /> customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, <br /> tenant or any other party the reasonable mazket value of such items must be added to the estimated cost ( <br /> or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, �i <br /> the City may request the submission of a signed copy of the actual contract. Ii <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is � <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. �' <br /> The undersigned hereby applies to the Ciry for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ord' s e City and the regulations of the Minnesota <br /> State Building Code, and certif that all tements de on this application are complete, true ; <br /> and correct. <br /> f <br /> Applicant's Signature: � Date: —Z �' � � <br /> � <br /> I <br /> Approved By: Date: I <br /> . . 4 <br />` � � ' � <br /> ; <br />